=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790960425
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DONNA MARIE PICHLER R.N.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/31/2007
-----------------------------------------------------
Last Update Date | 12/31/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 931 BUENA VISTA ST HEALTHCARE PARTNERS CARDIAC REHAB 5TH FLOOR
-----------------------------------------------------
City | DUARTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91010-1712
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-739-1378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1678 N QUINCE WAY
-----------------------------------------------------
City | UPLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91784-1926
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC3500X
-----------------------------------------------------
Taxonomy Name | Cardiac Rehabilitation Registered Nurse
-----------------------------------------------------
License Number | 416116
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------